What is labor and delivery?

At the end of the
third
trimester of pregnancy, your body will begin to show
signs that it is time for your baby to be born. The process that leads to the
birth of your baby is called labor and delivery. Every labor and delivery
includes certain stages, but each birth is unique. Even if you have had a baby
before, the next time will be different.

Giving birth to a baby
is hard work. It can also be scary, thrilling,
and unpredictable. Learning all you can ahead of time will help you be ready
when your time comes.

What are the stages of labor?

There are three
stages of labor. The first stage includes early labor and active
labor. The second stage lasts through the birth,
with the baby traveling down and out of the birth canal. The third stage is
after the birth, when the placenta is delivered.

Stage one. The muscles of the uterus start to tighten (contract) and then relax. These contractions help to thin (efface) and open (dilate) the cervix so the baby can pass through the birth canal.

Stage one has three phases:

Early. Early contractions are usually irregular, and they usually last less than a minute. The early phase of labor can be uncomfortable and may last from a few hours to days.

Active. Contractions become strong and regular and last about a minute. This is the time to go to the hospital or birthing center. The pain of contractions may be moderate or intense.

Transition. The cervix will open completely. If there are no problems, the baby should be in position to be born.

Stage two. The cervix is dilated completely and the baby is born.

Stage three. This stage occurs after the baby is born. You have contractions until the placenta is delivered.

How can you manage pain?

Having a support person, trying different positions, or using
breathing exercises may help you cope with labor pain. You also can listen to music or use imagery to distract you and help you relax. Some women labor in water or take a shower.

Many women ask for pain medicine, such as an epidural injection, which partially or fully numbs the lower
body. Even if you plan to not use pain medicine (natural childbirth), it can be comforting to know
that you can get pain relief if you want it.

How can you prepare for labor and delivery?

Getting regular exercise during pregnancy will help you handle the
physical demands of labor and delivery. Try adding
Kegel exercises to your daily routine. They strengthen
your pelvic floor muscles. This helps prevent a long period of pushing during
labor.

In your sixth or seventh month of pregnancy, consider
taking a childbirth education class with your partner or support
person. It can teach you ways
to relax and the best ways for your support person to help you.

There are many decisions to make about labor and delivery. Before your
last weeks of pregnancy, be sure to talk to your doctor or nurse-midwife about
your birthing options and what you prefer.

You can write down all of your preferences as a birth
plan. This gives you a chance to state how you would most like things to be
handled. Just keep in mind that it is not possible to predict exactly what will
happen during labor and delivery.

What can you expect right after childbirth?

Now you get
to hold and look at your baby for the first time. You may feel excited,
tired, and amazed all at the same time.

If you plan to
breastfeed, you may start soon after birth.
Don't be surprised if you have some trouble at first. Breastfeeding is
something you and your baby have to learn together. You will get better with
practice. If you need help getting started, ask a nurse or breastfeeding
specialist (lactation consultant).

In the hours after
delivery, you may feel sore and need help going to the bathroom. You may have
sharp, painful contractions for several days as your uterus
shrinks in size.

Planning for Birth

Consider a birth plan

During
your prenatal visits, talk with your doctor or midwife about your labor and
delivery options. You may want to write them
down as a birth plan. It's an ideal
picture of what you would like to happen.

But try to be flexible. No labor and delivery can be
predicted or planned. So give yourself permission to change your mind at any
time. And be prepared for your childbirth to be different from what you
planned. If an emergency arises, your doctor has a
responsibility to ensure both your safety and your baby's safety. You may still
share in decisions, but your choices may be limited.

What to put in a birth plan

Where you want to have your baby. Most women
choose to work with a doctor and have their baby delivered in a hospital.
Women at low risk for problems may choose to work with
a midwife or have their baby at a birth center.

Who you want to be
with you. You may want to have family and friends around you or only the baby's
other parent or another support person, such as a doula.

Comfort measures you
want to try. Breathing techniques, laboring in water, trying different
positions, and having one-on-one support may help you manage pain.

Your preferences for medical treatments. Consider what type of
pain medicine you would prefer, even if you don't think you'll need it. Just keep in
mind that you may not always get to choose.

How your baby will be
cared for after delivery. This might include having your baby stay in the room
with you rather than going to the nursery, delaying some tests and procedures,
and getting help with starting to breastfeed.

This is also a good time to decide whether you'll attend (if you haven't
already) a
childbirth education class, starting in your 6th or
7th month of pregnancy.

To help you get started on writing a birth plan, fill out the My Birth Plan form(What is a PDF document?). Take it to your next appointment to discuss your wishes with your doctor or midwife.

What to expect at the hospital

You may feel more calm and prepared for labor if you know what is likely to happen when you get to the hospital.

Most hospitals and birthing centers have birthing rooms
where women can labor, deliver, and recover. Providing that you have an
uncomplicated birth, you can probably be in the same birthing room for your
entire stay. If your delivery becomes complicated, you can be quickly moved to
a delivery room equipped to handle the problem.

If you arrive at the hospital or
birthing center in early labor that is progressing quickly, you can expect some or all of the following:

Your blood pressure, pulse, and temperature will be
checked.

You will be asked about the timing and strength of your
contractions and whether your water has broken (your membranes have ruptured).

Electronic fetal heart monitoring will be used to record the fetal heart rate as you have contractions. Fetal heart rate shows whether the
baby is doing well or is in trouble.

You may have an
intravenous (IV) needle inserted, in case you need
extra fluids or medicine later on.

You may be encouraged to walk. Walking helps many women
feel more comfortable during early labor.

Newborn care decisions

Before your baby is born,
plan ahead about:

Keeping your baby with you for at least 1
hour after birth, for bonding. (Many hospitals allow rooming-in, with no
mother-baby separation during the entire hospital stay.)

Preventing breastfeeding problems. You can plan ahead for
breastfeeding support in case you need it. Check around for a
lactation consultant. Some hospitals have them
in-house. You can also make sure that hospital staff knows not to give your
baby supplemental formula, unless there is a medical need.

Delaying
certain procedures—such as a vitamin K injection, a heel prick for a blood
test, and the use of eye medicines—so that you have more time to bond with your baby in the hours after birth.

Whether and when you'd like visitors,
including children in your family.

Signs of Labor

No one can predict when labor will start. One woman can have all
the signs that her body is ready to deliver, yet she may not have the baby for
weeks. Another woman may have no advance signs before she goes into active
labor. First-time deliveries are harder to predict.

Signs that labor may start soon

Late in your pregnancy, your doctor or midwife will tell you what to do when you think you are in labor. Early labor can be different for every woman. At first, your contractions may not be regular, and they may happen only now and then.

Braxton Hicks contractions may become more frequent and stronger, and perhaps a little
painful. You may also feel cramping in the groin or rectum or an ongoing ache
low in your back.

Your amniotic sac may break (rupture of the membranes). In most cases, rupture of the membranes occurs after
labor has already started. In some women, this happens before labor starts.
Call your doctor right away or go to the hospital if you think
your membranes have ruptured.

The key to knowing when you're in labor is that the contractions start to get longer, stronger, and closer together. You will feel them even when you change positions and are walking or moving around. After a while, it will become hard for you to talk during a contraction. You may have to stop to focus on your breathing.

When to call a doctor

Many women stay at home during early labor. During this time, it's important to know when to call your doctor or midwife.

You or someone else should
call 911 or other emergency services immediately if you think you may need
emergency care. For example, call if you:

Have severe vaginal bleeding.

Have
severe pain in your belly or pelvis.

Call your doctor now or go to your hospital's labor and delivery unit immediately if you:

Have any vaginal
bleeding.

Have had regular contractions for an hour. This means about 4 or
more in 20 minutes, or about 8 or more in 1 hour, even after you have had a
glass of water and are resting.

Have a sudden release of fluid from your vagina. It is possible
to mistake a leak of
amniotic fluid for a problem with bladder
control.

Have low back pain or pelvic pressure that does not go
away.

Have noticed that your baby has stopped moving or is moving much
less than normal. See
kick counts for information on how to check your
baby's activity.

Managing Pain

You can choose from several types of pain relief for childbirth. These include medicine or breathing techniques, as well as comfort measures. You also can use a combination of these choices.

Comfort measures

There are many ways to reduce the
stresses of labor and delivery. "Natural" childbirth techniques (without medicine) may help reduce pain and help you feel a sense of control during
labor. Consider:

Distraction. During early
labor, you can walk, play cards, watch TV, take a shower, or listen to music to help take
your mind off your contractions.

Massage.
Massage of the shoulders and lower back during contractions may ease your pain.
Strong massage of the back muscles (counterpressure) during contractions may
help relieve the pain of
back labor. Tell your labor coach exactly where to
push and how hard to push.

Imagery. Imagery
is using your imagination to decrease your pain. For instance, to help manage
pain, visualize contractions as waves rolling over you. Picture a peaceful
place, such as a beach or mountain stream, to help you relax between
contractions.

Changing positions during labor. Walking, kneeling, or sitting on a big rubber ball (birth ball) are good options. For more information see Labor Positions.

Focused breathing techniques. Breathing
in a rhythm can distract you from pain. Childbirth education classes will teach
you different methods of focused breathing.

Other techniques without medicine

Hypnosis. This is a low-risk way of managing labor pain and
anxiety that works for some women.footnote 3

Acupuncture. Small studies suggest that
acupuncture is a low-risk, effective way of managing
labor pain for some women.footnote 3

Pain relief with medicine

Your options for pain relief with medicine may include:

Opioids (narcotics), which are used to
reduce anxiety and partially relieve pain. An opioid is less likely than
epidural anesthesia to lead to an assisted (forceps or vacuum)
delivery.footnote 4 But an opioid is usually not used when you are close to delivery, because it can affect a newborn's breathing.

Epidural anesthesia, which is an ongoing injection of pain medicine into the
epidural space around the spinal cord. This partially or fully numbs the lower
body.

Pudendal and paracervical blocks. These are injections of pain medicine into the pelvic area to reduce labor pain. Pudendal is one of the safest forms of anesthesia for numbing the area where
the baby will come out. It can be helpful with fast labor when a little pain
medicine is needed close to delivery.

Some pain-relief medicines aren't the type that you
would request during labor. They are used as part of another procedure
or for an emergency delivery. But it's a good idea to know about them.

Local anesthesia is the injection of
numbing pain medicine into the skin. This is done before inserting an
epidural or before making an incision (episiotomy) that widens the vaginal opening for the
birth.

Spinal block is an injection of pain medicine into
the spinal fluid. It quickly and fully numbs the pelvic area for assisted
births, such as a
forceps or
cesarean delivery.

General anesthesia is the use of inhaled or
intravenous (IV) medicine, which makes you
unconscious. It has more risks, yet it takes effect much faster than epidural
or spinal anesthesia. So general anesthesia is usually only used for some
emergency C-sections that require a rapid delivery.

Types of Delivery

Most babies are born in a vaginal delivery. But in some cases, other types of delivery occur by choice or because of an emergency.

Vaginal birth

During labor, the uterus contracts regularly to thin and open (efface and dilate) the cervix and push the baby out through the birth canal. It can take many hours or days for the cervix to open all the way so you can begin pushing.

Cesarean birth

A cesarean section is the delivery of a baby through a cut (incision) in the mother's belly and uterus. It is often called a C-section. In most cases, a woman can be awake during the birth and be with her newborn soon afterward.

A C-section may be planned or unplanned. In most cases, doctors do cesarean sections because of problems that arise during labor. For more information, see the topic Cesarean Section.

Vaginal birth after cesarean

In the past, a woman who had one C-section delivery had to have all of her other babies by C-section. But depending on the reason for your first C-section and the type of incision that was made, you may be able to deliver your next baby vaginally.

Stages of Labor

The process of having a baby occurs in several stages over many hours or even a few days—from early labor through delivering the baby and the placenta. During labor, contractions in your uterus open your cervix and move the baby into position to be born.

Stage one: Early, active, and transition

Early labor

Early labor is often the longest part of the
birthing process, sometimes lasting 2 to 3 days. Uterine contractions:

Are mild to moderate (you can talk while they
are happening) and last about 30 to 45 seconds.

May be irregular (5
to 20 minutes apart) and may even stop for a while.

Open (dilate)
the
cervix to about
3 cm (1 in.). First-time
mothers can have many hours of early labor without the cervix dilating.

It's common for women to go to the hospital during early
labor and be sent home again until they are in active labor or until their
"water" breaks (rupture of the membranes). This phase of labor can be long and
uncomfortable.

Active labor

The active stage of
labor starts when the cervix is about
3 cm (1.2 in.) to
4 cm (1.6 in.) dilated. This
stage is complete when the cervix is fully
effaced and dilated and the baby is ready to be pushed
out.

Compared with early labor, the
contractions during active labor are more intense and more
frequent (every 2 to 3 minutes) and longer-lasting (50 to 70 seconds). Now is
the time to be at or go to the hospital or birthing center. If your
amniotic sac hasn't broken before this, it may now.

As your contractions get stronger, you may:

Feel restless or excited.

Find it
hard to stand up.

Not be allowed to eat or drink. Some
hospitals let you drink clear liquids. Others may only allow you to
suck on ice chips or hard candy.

Transition

The end of active labor is called the transition phase. As the baby moves down, your
contractions become more intense and longer and come even closer together.

When you reach transition, your delivery isn't far off. During
transition, you will be self-absorbed, concentrating on what your body is
doing. You may be annoyed or distracted by others' attempts to help you but still feel you need them nearby as a support. You may feel increasingly
anxious, nauseated, exhausted, irritable, or frightened.

A mother
in first-time labor will take up to 3 hours in transition, and a mother who has
vaginally delivered before will usually take no more than an hour. Some women
have a very short, if intense, transition phase.

Stage two: The baby is born

The second stage is the actual birth, when the baby is pushed out by the contractions. This pushing stage can be as short as a few minutes or as
long as several hours. You are more likely to have a fast labor if you have
given birth before. During the second stage:

Uterine contractions will feel different.
Though they are usually regular, they may slow down to every 2 to 5 minutes,
lasting 60 to 90 seconds. If your labor stalls, changing positions may help. If
not, your doctor may recommend using medicine to stimulate
(augment) contractions.

You may have a strong urge to push or bear down with each
contraction.

You may need to change position several times to find
the right
birthing position for you.

You can have a
mirror positioned so you can watch your baby as the head comes through the vagina (called crowning).

When the baby's head crowns, you will
feel a burning pain. If this is happening quickly, your doctor may
advise you not to push every time, which may give the
perineum, which is the area between the
vulva and the
anus, a chance to stretch without tearing.

Your
medical staff will be ready to handle anything unexpected. This is a time when your doctor or
nurse-midwife will be deciding what is best for you and your baby.

Stage three: The placenta is delivered

After your baby
is born, your body still has some work to do. This is the third stage of labor,
when the
placenta is delivered. You will still have
contractions. These contractions make the placenta separate from the inside of
the uterus, and they push the placenta out. Your medical staff will help you
with this. They will also watch for any problems, such as heavy bleeding,
especially if you have had it before.

You may be given some medicine to help the uterus
contract firmly. Oxytocin (such as Pitocin) may be given as a shot or in a vein (intravenously) after the placenta is delivered. Oxytocin is given to make your uterus shrink and bleed less. (This is the same medicine that is sometimes used to make contractions more regular and frequent during labor.) Breastfeeding right away can also help the uterus shrink
and bleed less.

The third stage can be as quick as 5 minutes. With
a
preterm birth, it tends to take longer. But in most
cases, the placenta is delivered within 30 minutes. If the placenta doesn't
fully detach, your doctor or nurse-midwife will probably reach inside the
uterus to remove by hand what is left inside. Your contractions will continue
until after the placenta is delivered, so you may have to concentrate and
breathe until this uncomfortable process is complete.

Labor Positions

In most cases, you don't have to lie in bed the whole time you're in labor. (If you have an epidural or have certain health problems, you may have to stay in bed.) You can choose whichever position feels most comfortable. You may want to walk, sit on a big rubber ball, or kneel. The position that feels best for you may change as you move through labor:

Moving around and changing positions during labor may help you feel more comfortable and might help reduce the length of labor.footnote 5

Birthing positions

Birthing positions
for pushing include squatting, reclining, or using
a birthing chair, stool, or bed. You may find that certain positions are more comfortable than others during the pushing stage. Speak to your doctor or midwife about different birthing positions before your labor begins.

Kneeling, getting down on your hands and knees, or leaning onto a birthing ball may help to take pressure off your back. This position might also help with back labor.

Squatting may help you push more effectively.

Lying on your back in a semi-reclining position with your legs supported by stirrups is a common birthing position used in the United States. While pushing, your doctor or midwife may have you grab behind your knees and pull up.

Lying on your side is helpful if you are tired of lying on your back.

Some birthing centers use a birthing stool or chair during the pushing stage. A birthing chair may help you feel more comfortable.

Medical Procedures

In some cases, a woman may need medical help to give birth. For instance, labor may stall, or the baby may need help to get through the birth canal. Sometimes what starts as a routine vaginal birth may end in a cesarean delivery to make sure the mom and baby are safe.

Procedures to help with delivery

Sometimes your doctor may need to use different procedures to help deliver the baby.

Forceps delivery or vacuum extraction is used to assist a vaginal delivery. This may be needed when labor is
stalled at the pushing stage or when the baby shows signs of distress at the
pushing stage and needs to be delivered quickly.

Episiotomy widens
the
perineum with an incision. This is sometimes used to
deliver the baby's head more quickly, when there are signs of distress.

Right After the Birth

You may feel excited,
tired, and amazed all at the same time after delivery. You may feel a great
sense of calm, peace, and relief as you hold, look at, and talk to your baby.

Breastfeeding

During the first hour after the birth, you can also expect to start breastfeeding, if you plan to breastfeed.

If you breastfeed,
don't be surprised if you and your baby have some trouble doing it at first.
Breastfeeding is a learned technique, so you will get better at it with practice.
You may have a breastfeeding specialist (lactation consultant) in the hospital to help you get started.

For information
about getting a good start with breastfeeding and preventing problems,
see:

Your first hours of recovery

You may have
shaking chills right after delivery. This is a common reaction in the hours
after delivery. A warm blanket may help you feel more comfortable.

During the first hours after the birth, your health professional or a
nurse will:

Massage your uterus by rubbing your lower abdomen about every
15 minutes. Later, you will be taught to massage your own uterus. This helps it
tighten (contract) and stop bleeding.

Check your bladder to make
sure it isn't full. A full bladder puts pressure on your uterus, which
interferes with contractions. You will be asked to try to urinate, which may be
hard because of pain and swelling. If you can't urinate, a tube (catheter) can be used to empty your bladder.

Check your blood
pressure frequently.

Repair the area between your vagina and anus (perineum) if it tore or if you had an incision (episiotomy).

Remove the small tube in your
back if you had
epidural anesthesia. If you plan to have a
tubal ligation surgery to prevent future pregnancy,
the catheter will be left in.

An Rh immunoglobulin shot (such as RhoGAM). If you have Rh-negative blood, you may get a shot of Rh immunoglobulin after delivery if your newborn is Rh-positive. For more information see the topic Rh Sensitization During Pregnancy.

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